Hepatitis C is a viral disease that leads to swelling (inflammation) of the liver.

Hepatitis C infection is caused by the hepatitis C virus (HCV). People who may be at risk for hepatitis C are those who:

• Have been on long-term kidney dialysis
• Have regular contact with blood at work (for instance, as a health care worker)
• Have unprotected sexual contact with a person who has hepatitis C
• Inject street drugs or share a needle with someone who has hepatitis C
• Received a blood transfusion before July 1992
• Received blood, blood products, or solid organs from a donor who has hepatitis C
• Share personal items such as toothbrushes and razors with someone who has hepatitis C
• Were born to a hepatitis C-infected mother

Other hepatitis virus infections include hepatitis A and hepatitis B. Each viral hepatitis infection is caused by a different virus.

Many people who are infected with the hepatitis C do not have symptoms.

If the infection has been present for many years, the liver may be permanently scarred, a condition called cirrhosis. In many cases, there may be no symptoms of the disease until cirrhosis has developed.

The following symptoms could occur with hepatitis C infection:

• Abdominal pain (right upper abdomen)
• Ascites
• Bleeding varices (dilated veins in the esophagus)
• Dark urine
• Fatigue
• Generalized itching
• Jaundice
• Loss of appetite
• Low-grade fever
• Nausea
• Pale or clay-colored stools
• Vomiting

Hepatitis C is often found during blood tests for a routine physical or other medical procedure.

• Elevated liver enzymes
• ELISA assay to detect hepatitis C antibody
• Hepatitis C PCR test
• Hepatitis C genotype. Six genotypes exist. Most Americans have genotype 1 infection, which is the most difficult to treat.
• Hepatitis virus serology
• Liver biopsy

There is no cure for hepatitis C, but medications in some cases can suppress the virus for a long period of time.

Some patients with hepatitis C benefit from treatment with interferon alpha or a combination of interferon alpha and ribavirin. Interferon alpha is given by injection just under the skin and has a number of side effects, including:

• Depression
• Fatigue
• Fever
• Flu-like symptoms
• Headache
• Irritability
• Loss of appetite
• Low white blood cell counts
• Nausea
• Thinning of hair
• Vomiting

Treatment with interferon alpha may also affect the production of white blood cells and platelets. Most patients receive weekly injections with a form called pegylated interferon alpha. Interferon is given along with antiviral medication, most commonly ribavirin.

Ribavirin is a capsule taken twice daily. The major side effect is low red blood cells (anemia). Ribavirin also causes birth defects. Women should avoid getting pregnant during, and for 6 months following, treatment.

A "sustained response" means that the patient remains free of hepatitis C virus 6 months after stopping treatment. This does not mean that the patient is cured, but that the levels of active hepatitis C virus in the body are very low and are probably not causing more or as much damage.

Rest may be recommended during the acute phase of the disease when the symptoms are most severe. All patients with hepatitis C should get vaccinated against hepatitis A and B.

People with hepatitis C should also be careful not to take vitamins, nutritional supplements, or new over-the-counter medications without first discussing it with their health care provider.

People with hepatitis C should avoid any substances that are toxic to the liver (hepatotoxic), including alcohol. Even moderate amounts of alcohol speed up the progression of hepatitis C, and alcohol reduces the effectiveness of treatment.

You can often ease the stress of illness by joining a support group of people who share common experiences and problems. See liver disease - resources.

Hepatitis C is one of the most common causes of chronic liver disease in the United States today. People with this condition may have:

• Chronic liver infection
• Cirrhosis
• Need for a liver transplant

• Chronic hepatitis
• Cirrhosis

Call your provider if symptoms of hepatitis develop, or if you believe you have been exposed to the hepatitis C virus.

Avoid contact with blood or blood products whenever possible. Health care workers should follow precautions when handling blood and bodily fluids.

Do not inject illicit drugs, and especially do not share needles with anyone. Be careful when getting tattoos and body piercings.

Sexual transmission is low among stable, monogamous couples. A partner should be screened for hepatitis C. If the partner is negative, the current recommendations are to make no changes in sexual practices.

People who have sex outside of a monogamous relationship should practice safer sex behaviors to avoid hepatitis C as well as sexually transmitted diseases, including HIV and hepatitis B.

Currently there is no vaccine for hepatitis C.

Shiffman ML, Suter F, Bacon BR, et al. Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med. 2007;357:124-134.

Wong T, Lee SS. Hepatitis C: a review for primary care physicians. CMAJ. 2006;174:649-659.

Rocca LG, et al. Management of patients with hepatitis C in a community setting: diagnosis, discussions and decisions to treat. Ann Fam Med. 2004;2:116-124.